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Key learning points

Cognitive biases

Escalation begins with correctly identifying an evolving pathology or a potentially critical situation.

Mistakes evaluating and interpreting information may interfere with that assessment and result in missed opportunities to provide timely care.

Loss of situational awareness

Intrapartum care is a high-risk environment for loss of situational awareness.

Understanding when it is lost and how to minimise risk is essential to maintaining safety.

Multidisciplinary team dynamics

Unbalanced skill sets within an unfamiliar team can result in problems identifying the need for escalation and a lack of assertiveness in executing the process.

Challenging a decision

All members of the multidisciplinary team must feel empowered to challenge a decision that they feel is incorrect.

Where there is disagreement, a third party should be called to provide another opinion and fresh perspective.

Timely obstetric reviews

If an urgent medical review is needed and the on-site obstetric team is unable to deliver care in the required time frame, the consultant must be informed.

Handover

Loss of escalation momentum can occur owing to incomplete transfer of information between staff.

A high-quality handover is essential for continuity of care and for maintaining situational awareness of the unit as a whole.

Emergency escalation protocols

Incorrect methods of emergency escalation delay urgent assistance.

All staff must be familiar with the location of local emergency buzzers and switchboard escalation protocols.